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General Information
A Nephrologist is a physician who treats patients with kidney problems and related hypertension or high blood pressure issues. Once a patient has been diagnosed with kidney disease, an early referral to a Nephrologist is important in preserving and protecting the kidney function. As a specialist in kidney disease, a Nephrologist has the best knowledge and skill to work with a patient in developing a plan of care specific to his/her needs.
CKD is defined as a decreased level of kidney functions or the evidence of kidney damage for greater than three months. Individuals at risk for developing kidney disease are those with diabetes, high blood pressure, or a family history of kidney disease
eGFR is the Estimated Glomerular Filtration Rate. This is the best test to measure the level of kidney function and helps determine the stage of kidney disease. It can be calculated from a combination of a blood creatinine test, age, body size, and gender. If the GFR number is low, the kidney(s) are not operating as well as they should. The earlier kidney disease is detected, the better the chance is of slowing or stopping its progression. This test is part of a Basic Metabolic Panel (BMP), Comprehensive Metabolic Panel (CMP), and Renal Function Panel (RFP).
Once CKD is diagnosed, it is important to determine the level of kidney function. The National Kidney Foundation has identified five (5) stages of CKD. Each stage represents a level of kidney function, as defined by the Glomerular Filtration Rate (eGFR).
- Stage 1: eGFR >90 – Kidney(s) are operating at 90- 100% efficiency
- Stage 2: eGFR 60-89 – Kidney(s) are operating at 60- 89% efficiency
- Stage 3: eGFR 30-59
- Stage 3a: eGFR 45-59 – Kidney(s) are operating at 45-59% efficiency
- Stage 3b: eGFR 30-44 – Kidney(s) are operating at 30-44% efficiency
- Stage 4: eGFR 15-29 – Kidney(s) are operating at 15-29% efficiency
- Stage 5: eGFR <15 – Kidney(s) are operating at less than 15% efficiency
Hemodialysis, peritoneal dialysis, home hemodialysis, and a kidney transplant are all treatment options. Kidney transplantation surgically places a healthy kidney from another person into a patient’s body. The donated kidney does the work that the patient’s failed kidneys used to do. One additional option is to refuse or withdraw from treatment. However, for many people, dialysis and transplantation is used to extend and/or improve the quality of life. For others, these treatment options may seem like a burden and only to prolong suffering. A patient does have the right to refuse or withdraw dialysis if there is a feeling that there is no hope of improving the quality of life with dignity and meaning.
Dialysis is a process that cleans and filters blood. There are three types of dialysis: hemodialysis, peritoneal dialysis, and home hemodialysis.
Hemodialysis
- Hemodialysis is a medical procedure to remove fluid and waste products from the blood and to correct electrolyte imbalances. This is accomplished using a machine and a dialyzer, also known as an artificial kidney. This is typically done in the outpatient setting at an In-Center Hemodialysis (ICHD) unit 3 times a week for an average of 4 hours (the Nephrologist will adjust the prescription (treatment time) as necessary).
Peritoneal Dialysis
- Peritoneal Dialysis (PD) is a dialysis technique that uses the patient’s own body tissues inside the abdominal cavity as a filter. A plastic tube called a dialysis catheter is surgically placed through the abdominal wall, into the abdominal cavity. A special fluid is then flushed into the abdominal cavity and washed around the intestines. The intestinal walls act as a filter between this fluid and the bloodstream. By using different types of solutions, waste products and excess water can be removed from the body. This form of dialysis can be done either manually of by a machine at home, thereby avoiding hospitalization or receiving dialysis treatment at a dialysis center.
Home Hemodialysis
- The patient is performing the requirements for treatment in the comfort of his/her home with Home Hemodialysis (HHD). During home hemodialysis, blood flows from the patient’s vascular access through a dialysis machine. The dialysis machine cleanses the blood of extra waste and fluids and then sends the clean blood back from the body. Patients on home hemodialysis have the option of performing more frequent or longer dialysis treatments, which may contribute to better clinical outcomes and an overall improved quality of life.
For hemodialysis, it is necessary to create a vascular access or pathway to your blood. The access is usually created in your arm during a short surgery. One type of access is a fistula, another type of access is a graft. In some cases, an external catheter may be inserted into a vein in your chest or neck. A catheter is usually temporary and replaced by a fistula or graft.
Insurance & Billing
At Renal Associates of West Michigan, PC, we strive to be able to accept every insurance. Some major insurances we accept are Aetna, Blue Cross Blue Shield (BCBS), Blue Care Network (BCN), Cigna, Cofinity (First Health), Humana, McLaren Health, Medicaid, Medicaid, Meridian Health, Molina Healthcare, Priority Health, United Healthcare, and Veterans Insurance (including Tricare and TriWest (Community Choice Program)). Please give our billing department a call if you have a question regarding what insurances we take at (616) 752-6235, option 4
If we are billing your insurance, please provide the receptionist with your insurance information, including any updates or changes as they occur. A copy of your insurance card(s) and driver’s license are required at every visit to ensure proper billing processes.
Co-Pays
- For physician visits, your co-pay will be collected at the time of service. Network physicians with your payor are obligated to collect the co-pay at the time of service.
- You will be billed for any co-pay/deductible associated with hospital care, transplant management, and dialysis and/or access intervention procedures.
Co-Insurance
- In addition to co-pays, some payors have a co-insurance amount that is due as part of the service delivered. The amount of co-insurance due is based upon the individual policy for each patient.
Yearly Deductible
- Some patients have a set yearly deductible in addition to co-pays, or co-insurance. This is an amount set by your insurance carrier. Charges that are applied to your deductible will be billed to you. We will not be able to determine the deductible amount due prior to your service. If you have questions regarding your deductible, you will need to direct those to your insurance carrier.
Insurance Coverage
- Insurance coverage does not guarantee full payment for services provided. You will be billed for any fees determined by your insurance plan to be your responsibility. If you would like information regarding your payment responsibility for any of the services mentioned above, including physician office visits, please contact our billing office at (616) 752-6235, option 4. Our knowledgeable billing staff will be happy to answer your questions.